Organization
ENNIS PHARMACY AND YESTERDAY'S SODA FOUNTAIN, INC
Active
Other names
ennis health mart pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY A CROY CPT (PHARMACY TECHNICIAN/OWNER)
(406) 682-4246
Entity
Organization
Contact information
Practice address
124 EAST MAIN STREET, ENNIS, MT 59729-0306
(406) 682-4246
(406) 682-7568
Mailing address
PO BOX 306, 124 EAST MAIN STREET, ENNIS, MT 59729-0306
(406) 682-4246
(406) 682-7568
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
807
MT
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
221377
—
MT
Enumeration date
02/12/2007
Last updated
02/08/2024
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